Similarities and special features of modern approaches to surgical treatment of intra-articular fractures of tibial proximal and distal metaepiphyses

Abstract

SummaryIntroduction. Analysis of special scientific literature concerning the modern principles of diagnostics, preop-erative planning and surgical treatment of intra- articular fractures of two localizations: proximal and distal me-taepiphyses of the tibia, was carried out. Aim of the review. To evaluate, through the analysis of specialized scientific publications, similarities and differences in classification approaches, diagnostic methods, princi-ples of planning and performing osteosynthesis in pa-tients with intra-articular fractures of the proximal and distal metaepiphyses of the tibia. It is noted that the modern classifications of both tibial plateau and pilon fractures are based on the column theory. A thorough analysis of computed tomography data is necessary to precisely determine the fracture pattern. On this ba-sis, osteosynthesis surgeries are planned as to provide fixation of all damaged columns. Authors discuss the combinations of surgical approaches necessary for this purpose. Variants of osteosynthesis are also considered, with special attention paid to fixation of the posterior aspects of the tibial plateau and pilon. The differences in approaches to surgical treatment of patients with frac-tures of the tibial plateau and pilon are primarily due to a significant difference in the overall size of the tibia in the area of the knee and ankle joints and, in particular, with a significantly smaller volume of soft tissues at the level of the distal metaepiphysis of the tibia. These dif-ferences in anatomy should be taken into account by surgeons when choosing surgical approaches for osteo-synthesis of the discussed fractures. Conclusion. Adher-ence to the classical principles of surgical treatment of intra-articular fractures with the use of modern surgical approaches and osteosynthesis techniques is a sure way to improve specialized trauma care for a complex category of patients with intra-articular fractures of the proximal and distal tibial metaepiphyses, which should help to reduce the incidence of postoperative complica-tions and improve treatment outcomes.